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    <h1>keyose, your personal health record</h1>
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      <h2>Health Record #OVRQ273</h2>
<p>We do not collect personal data, therefore the confidentiality is guaranteed.</p>
<div class="errorExplanation" id="errorExplanation">
	<h2>2 errors prohibited this record from being saved</h2>
	<p>There were problems with the following fields:</p>
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		<li>Year of birth is not a number</li>
		<li>You are too old or too young to use this site</li>
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<form action="/record/edit/1775" method="post"><div style="margin:0;padding:0"><input name="authenticity_token" type="hidden" value="8f1156404e1fbcc7da14e342b0c34c7f2dffa003" /></div>

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  	<legend>Basic data</legend>
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      <label for="record_year_of_birth">Year of birth</label>
      <div class="fieldWithErrors"><input id="record_year_of_birth" name="record[year_of_birth]" size="30" type="text" value="asdf" /></div>
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      <label for="record_gender">Gender</label>

      <select id="record_gender" name="record[gender]"><option value="Male" selected="selected">Male</option>
<option value="Female">Female</option></select>
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      <label for="record_blood_type">Blood type <a href="#" onmouseover="showtip('This data could be critical if you need blood transfusion. In case you are not sure about your blood type, ask your healthcare provider and fill the <em>not known</em> option.')" onmouseout="hidetip()">[?]</a></label>
      <select id="record_blood_type" name="record[blood_type]"><option value="A+">A+</option>
<option value="A-">A-</option>

<option value="B+">B+</option>
<option value="B-">B-</option>
<option value="AB+">AB+</option>
<option value="AB-">AB-</option>
<option value="0+" selected="selected">0+</option>
<option value="0-">0-</option>
<option value="Not known">Not known</option></select>
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   	<legend>General data</legend>
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      <label for="record_allergies">Allergies <a href="#" onmouseover="showtip('This section should include allergies to drugs or other substances used in medical activities (as radiologic contrast, Iodum, Latex). When referring to a drug is always better to use the active principle (instead of the branch). It should include two sections: confirmed and suspected allergies. Confirmed allergies are those that have been certified by a doctor.<br />Allergies to dust, plants, and food should be also included specially if the patient will be hospitalized.<br />If the patient has suffered from a anaphylaxis (situation that requires hospitalization because of an allergic reaction) this must be included.<br /><br /><strong>For example</strong>:<br />Confirmed: Penicillin (anaphylaxis, 1995) and aspirin<br />Suspected: Iodum<br />Suspected: Carrots and onions<br />Confirmed: Bees')" onmouseout="hidetip()">[?]</a></label>
      <textarea cols="40" id="record_allergies" name="record[allergies]" rows="20" wrap="virtual">polvo, pendicilina, alcohol</textarea>
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      <label for="record_personal_history">Personal history <a href="#" onmouseover="showtip('This section should include the main diseases that the patient suffer from, with emphasis in the chronic conditions. The year when the condition was diagnosed should be stated. In some diseases is important to add also some information about the severity or the treatments. In women, an obstetric history is also important (age of first period, age of menopause, number of pregnancies, abortions and births). The toxic habits (tobacco, alcohol and other illegal drugs) should be included, with the quantity. The surgical interventions are also important (do not forget to include the year of the intervention).<br /><br /><strong>For example</strong>:<br />smoker 20 cigs per day.<br />hypertension (under treatment) since 1995<br />hypercholesterolemia (under treatment) since 2000<br />diabetes mellitus type 2 (under treatment with insulin) since 1998<br />appendectomy in 1986<br />first menstruation at 13y.o., 1 birth, 2 pregnancies.')" onmouseout="hidetip()">[?]</a></label>
      <textarea cols="40" id="record_personal_history" name="record[personal_history]" rows="20" wrap="virtual">asma</textarea>
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      <label for="record_family_history">Family history <a href="#" onmouseover="showtip('This section should include the relatives (parents, grandparents and siblings) diseases (mainly those that have a genetic influence). In case of death of parents the age should be included (is not the same that your father had a myocardial infarction with 80 years old than with 40.<br /><br /><strong>For example</strong>:<br />Father dead with Diabetes mellitus type 1 and a myocardial infarction with 60 y.o.<br />Mother alive with hypertension and depressive episodes.')" onmouseout="hidetip()">[?]</a></label>
      <textarea cols="40" id="record_family_history" name="record[family_history]" rows="20" wrap="virtual">diabetes</textarea>

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      <label for="record_medications">Medications <a href="#" onmouseover="showtip('This section should include the list of treatments the patient is recieving (that includes not only drugs but also oxygen at home for example). If you are taking alternative medicine treatments is a good idea to include them here (sometimes can interact with other drugs). Try to use the active principle with the branch between brackets. You should specify the quantity (in mgs for example) and how many times you take it per day.<br /><br /><strong>For example</strong>:<br />Ibuprofen 600 mg 3 per day.<br />Sildenafil (Viagra) 25 mg on demand.')" onmouseout="hidetip()">[?]</a></label>
      <textarea cols="40" id="record_medications" name="record[medications]" rows="20" wrap="virtual">paracetamol, amoxicilina
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      <label for="record_confidential">Confidential data <a href="#" onmouseover="showtip('This information is always confidential and noboby can access to it without you personal password.')" onmouseout="hidetip()">[?]</a></label>

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